medwireNews: A prospective analysis of the community-based ARIC cohort supports an increased serious infection risk for people with diabetes.
This relationship was not confined to foot infections, with a significant risk increase evident for all other categories of infection except for gastrointestinal, with the adjusted risk increase ranging from 1.49-fold for respiratory infections to 1.95-fold for postoperative infections.
“Our findings, along with results from prior reports, suggest that enhancing prevention and early treatment of infection in those with diabetes is needed to reduce infection-related morbidity and mortality,” say Elizabeth Selvin (Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA) and co-researchers.
The team studied 12,379 ARIC participants, aged 45–64 years at study entry, of whom 12% had diabetes, defined according to fasting (≥7.0 mmol/L) or nonfasting (≥11.1 mmol/L) glucose level at baseline, a self-reported diabetes diagnosis, or use of glucose-lowering medications.
During follow-up lasting a median of 23.8 years, 4229 people were admitted to hospital for infection. The rate per 1000 person–years was significantly higher among people with than without diabetes, at 25.4 versus 15.2, equating to a 1.67-fold increased risk after accounting for sociodemographic factors, socioeconomic factors, health insurance, health behaviors, and cardiometabolic factors.
The association with diabetes was particularly striking for foot infections, at a 5.99-fold increased risk, the researchers report in Diabetologia.
The association between diabetes and infection remained consistent across subgroups defined by sex, socioeconomic status, type of health insurance, and the presence or absence of obesity. But there were significant interactions by age and race, such that the impact of diabetes on infection was significantly greater in people younger than 55 years than in older people and in Black compared with White people.
Selvin and team suggest that lower engagement with healthcare or barriers to its access may contribute to this disparity, as may relatively poor glycemic control in these subgroups.
“Our results suggest that targeted efforts aimed at improving patient education, timely access to care and diabetes control may reduce infection morbidity in high-risk groups,” they write.
People with diabetes also had a significant 1.72-fold increased risk for infection mortality after adjusting for confounders. However, the researchers stress that mortality rates were low, at an age-adjusted 2.1 versus 1.2 per 1000 person–years for those with and without diabetes.
They note that current guidelines relating to the risk for infection in people with diabetes “are limited, focusing primarily on the receipt of vaccinations (e.g. influenza and pneumonia) and foot ulceration screenings to prevent infection in people with diabetes.”
The study authors conclude that their findings “support the emphasis of these preventive practices,” but also suggest “a need for broader guidance on infection prevention and management among those with diabetes.”
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Diabetologia 2021; doi:10.1007/s00125-021-05522-3